Deaths among youth with HIV less common; other complications emerge
Although opportunistic infections and death are less common among HIV-infected youth receiving ART, these patients are now experiencing higher rates of psychiatric, neurodevelopment, metabolic, inflammatory and genital tract diseases, according to a recent study published in Clinical Infectious Diseases.
“HIV-associated [opportunistic infections] characteristic of earlier periods in the HIV epidemic have become uncommon in HIV-infected youth,” Gayatri Mirani, MD, from Tulane University School of Medicine in New Orleans, and colleagues wrote. “Nevertheless, infections continue to occur and contribute to morbidity and mortality. Additional morbidities, including metabolic abnormalities, sexually transmitted infections, and psychiatric and neurodevelopmental disorders are becoming more common and may reflect aging, chronic HIV infection, ART-related toxicities, and chronic inflammation.”
Mirani and colleagues prospectively compared the incidence of complications and deaths among 1,201 youth with HIV enrolled in the IMPAACT P1074 study — a long-term, U.S.-based prospective multicenter cohort study conducted between 2008 and 2014 — with that of 2,358 patients enrolled in the PACTG P219C observational study, between 2004 and 2007. The researchers noted that, because P1074 continued long-term follow-up of some participants in P219C, 65% of participants were previously enrolled in P219C, and age and other characteristics were similar at enrollment for P1074.
Follow-up during P1074 revealed that common patient comorbidities included genital tract infections such as HPV and chlamydia, psychiatric conditions such as mood or anxiety disorders and neurodevelopment conditions such as learning and communication disorders. Asthma and pneumonia among the participants was also common.
When comparing P1074 and P219C participants, the researchers found a fivefold or greater incidence in the P1074 cohort for substance or alcohol abuse, diabetes, latent tuberculosis, atypical mycobacterial infections, vitamin D deficiency, metabolic bone disorders, anxiety disorders and fractures. The researchers noted 28 deaths during the study period, which they attributed to older age patients with lower CD4 counts and higher viral loads.
“Despite advances in ART, most deaths remain due to HIV-related conditions associated with virologic failure and immune suppression,” Mirani and colleagues wrote. – by Jeff Craven
Disclosure: Mirani reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.